Practice / Sample Questions

1. 67 year old man brought to A & E following an episode of collapse & ICD shocks x 4. He had dual chamber ICD implanted as secondary prevention 2 years ago, IHD with MI 20 years ago and depression. Medications: Bisoprolol 5mg OD, amiodarone 200mg OD & Asasantin BD. Examination: BP 133/44, pulse 60bpm, normal heart sounds and clear chest. Bloods: K4.1, Mg 0.85, CRP 7. ICD check showed all appropriate shocks. Echocardiogram showed severe LVSD (EF 20%) with global hypokinesia. What is best next step ?

2. 70 year old female seen in out patient clinic with 6 months history of shortness of breath on exertion. PMH: Hypertension and asthma. O/E BP 140/50, pulse 67bpm, normal heart sounds with soft early diastolic murmur at aortic area. Echocardiogram showed good LV systolic function, trileaflet aortic valve with moderate aortic regurgitation, mild mitral regurgitation & aortic root size 7.1cm. What is the best next step ?

3. You are reviewing a 56 year old man in OP clinic following an admission 6 months ago with NSTEMI. His coronary angiogram showed diffuse disease (mild to moderate) and it was decided for medical treatment. He is still experiencing angina after walking for 10 minutes or so. Medication: Bisoprolol 10mg OD, ISMN 20mg BD, aspirin 75mg OD, Ticagrelor 90mg BD and atorvastatin 80mg OD.Which of the following you will add to help the symptoms ?

4. 57 year old with history of MI and PCI 12 years ago. RF: hypertension and hyperlipidemia. Now presenting with exertional chest pain worsened by cold weather and stress. Medications bisoprolol 10mg OD, Simvastatin 40 mg OD, aspirin 75mg OD. Examination was unremarkable. MPS arranged (shown) . What is the abnormality seen ?

5. 46 year old man seen in the clinic with history of OOHA 6 weeks ago and had PPCI to LAD. Echocardiogram at the time of admission showed severe LVSD and mild MR. Medications: aspirin, ticagrelor, bisoprolol 2.5mg OD, ramipril 5mg BD, eplerenone 25mg OD & atorvastatin 80mg OD. On examination: BP 112/78mmHg, pulse 55 bpm, normal heart sound and clear chest. Repeat echocardiogram showed EF 30%. 24 hour tape showed runs of non-sustained VT. What is the best treatment ?

6. What is rhythm abnormality ?